Phosphatidylethanolamine Methyltransferase Activity Research Articles

Abstract 6379: Comparison of lipid profiles in children with solid tumors receiving chemotherapy and healthy children

Abstract Background: Lipid metabolism plays an important role in the regulation of synaptic function and plasticity.Cancer chemotherapy (chemo) can disturb the lipid profile, potentially linked with neuropsychological toxicities. This study aimed to compare the lipid profiles between children with cancer receiving chemo and healthy children. Methods: A prospective, observational study was conducted in 21 children with solid tumors enrolled from Children’s Healthcare of Atlanta (CHOA) and 16 controls. Children with solid tumors were consented precycle 2 chemo (T1) and followed at the end of chemo (T2). Controls completed one timepoint of data collection. At T1 (n=21) and T2 (n=13), fecal samples were collected for lipidomics analysis. Fecal lipids were processed using a high-resolution, untargeted lipidomics LC-MS approach. MetaboAnalyst and linear mixed models were used to analyze the data with false discovery rate correction (FDR 0.2). Results: There were no significant differences in age, sex, race, and body mass index between the groups. In total 241 lipid features were identified with high confidence and analyzed. A comparison between children with solid tumors at T2 (n=12) vs. controls (n=16) detected 8 differential lipids, which can be clustered into 4 classes, including 4 triglycerides (TG), 2 phosphatidylcholine (PC), 1 sphingomyelin (SM), and 1 lysophosphatidylcholine (LPC). Additionally, 24 differential lipids were detected for children with solid tumors from T1 to T2 (n=12), including 6 classes: 9 SM, 7 PC, 3 diacylglycerols (DG), 2 TG, 2 monoacylglycerols (MG), and 1 phosphatidylethanolamine (PE). Compared with controls, children with solid tumors at T2 had higher levels of SM (e.g., SM(d36:1)) and lower levels of TG (e.g., TG(18:0/18:0/20:0)), LPC (e.g., LPC(20:4)), and PC (e.g., PC(33:4). Compared with children at T1, those at T2 had higher levels of SM (e.g., SM(d36:1)), PE (e.g., PE(16:0p/20:4), PC (e.g., PC(30:0), and PC(36:1)), and lower levels of TG (e.g., TG(18:0/18:0/20:0) and TG(18:0/16:0/18:0)), LPC (e.g., LPC(20:4)), DG (e.g., DG(18:0/16:0) and DG(18:0/18:0)), and MG (e.g., MG(18:0)). Conclusion: Children with cancer chemo had alterations in fecal lipid profiles impacting the metabolism of PC, SM, TG, PE, MG, and DG. The increased PC and the dysregulation of LPC in comparison with controls suggest the decreased activity of phospholipase A2 (PLA2), primarily reported in inflammatory disease. Altered activity of lysophospholipid acyltransferase (LPCAT), diacylglyceride acyltransferase (DGAT), and phosphatidylethanolamine methyl transferase (PEMT) could also explain changes in PC and glycerolipids. Combined, these suggest dysregulation of the Kennedy or Lands pathways towards PC synthesis. Future work is needed to study whether the disturbed lipid metabolisms were associated with treatment toxicities and outcomes such as cognitive dysfunction based on literature. Citation Format: Jinbing Bai, Madelyn Houser, Melissa Martin, Christie Powell, Kristal Maner-Smith, Kathryn S. Sutton, Thomas Olson, Deborah W. Bruner. Comparison of lipid profiles in children with solid tumors receiving chemotherapy and healthy children [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6379.

PEMT, Δ6 desaturase, and palmitoyldocosahexaenoyl phosphatidylcholine are increased in rats during pregnancy

DHA is important for fetal neurodevelopment. During pregnancy, maternal plasma DHA increases, but the mechanism is not fully understood. Using rats fed a fixed-formula diet (DHA as 0.07% total energy), plasma and liver were collected for fatty acid profiling before pregnancy, at 15 and 20 days of pregnancy, and 7 days postpartum. Phosphatidylethanolamine methyltransferase (PEMT) and enzymes involved in PUFA synthesis were examined in liver. Ad hoc transcriptomic and lipidomic analyses were also performed. With pregnancy, DHA increased in liver and plasma lipids, with a large increase in plasma DHA between day 15 and day 20 that was mainly attributed to an increase in 16:0/DHA phosphatidylcholine (PC) in liver (2.6-fold) and plasma (3.9-fold). Increased protein levels of Δ6 desaturase (FADS2) and PEMT at day 20 and increased Pemt expression and PEMT activity at day 15 suggest that during pregnancy, both DHA synthesis and 16:0/DHA PC synthesis are upregulated. Transcriptomic analysis revealed minor changes in the expression of genes related to phospholipid synthesis, but little insight on DHA metabolism. Hepatic PEMT appears to be the mechanism for increased plasma 16:0/DHA PC, which is supported by increased DHA biosynthesis based on increased FADS2 protein levels.

In Vitro Assay to Measure Phosphatidylethanolamine Methyltransferase Activity.

Phosphatidylethanolamine methyltransferases are biosynthetic enzymes that catalyze the transfer of one or more methyl group(s) from S-adenosyl-L-methionine onto phosphatidylethanolamine, monomethyl-phosphatidylethanolamine, or dimethyl-phosphatidylethanolamine to give either monomethyl-phosphatidylethanolamine, dimethyl-phosphatidylethanolamine or phosphatidylcholine. These enzymes are ubiquitous in animal cells, fungi, and are also found in approximately 10% of bacteria. They fulfill various important functions in cell physiology beyond their direct role in lipid metabolism such as in insulin resistance, diabetes, atherosclerosis, cell growth, or virulence. The present manuscript reports on a simple cell-free enzymatic assay that measures the transfer of tritiated methyl group(s) from S-[Methyl-(3)H]adenosyl-L-methionine onto phosphatidylethanolamine using whole cell extracts as an enzyme source. The resulting methylated forms of phosphatidylethanolamine are hydrophobic and thus, can be separated from water soluble S-[Methyl-(3)H]adenosyl-L-methionine by organic extraction. This assay can potentially be applied to any other cell types and used to test inhibitors/drugs specific to a phosphatidylethanolamine methyltransferase of interest without the need to purify the enzyme.

Dysregulated Hepatic Methionine Metabolism Drives Homocysteine Elevation in Diet-Induced Nonalcoholic Fatty Liver Disease.

Methionine metabolism plays a central role in methylation reactions, production of glutathione and methylarginines, and modulating homocysteine levels. The mechanisms by which these are affected in NAFLD are not fully understood. The aim is to perform a metabolomic, molecular and epigenetic analyses of hepatic methionine metabolism in diet-induced NAFLD. Female 129S1/SvlmJ;C57Bl/6J mice were fed a chow (n = 6) or high-fat high-cholesterol (HFHC) diet (n = 8) for 52 weeks. Metabolomic study, enzymatic expression and DNA methylation analyses were performed. HFHC diet led to weight gain, marked steatosis and extensive fibrosis. In the methionine cycle, hepatic methionine was depleted (30%, p< 0.01) while s-adenosylmethionine (SAM)/methionine ratio (p< 0.05), s-adenosylhomocysteine (SAH) (35%, p< 0.01) and homocysteine (25%, p< 0.01) were increased significantly. SAH hydrolase protein levels decreased significantly (p <0.01). Serine, a substrate for both homocysteine remethylation and transsulfuration, was depleted (45%, p< 0.01). In the transsulfuration pathway, cystathionine and cysteine trended upward while glutathione decreased significantly (p< 0.05). In the transmethylation pathway, levels of glycine N-methyltransferase (GNMT), the most abundant methyltransferase in the liver, decreased. The phosphatidylcholine (PC)/ phosphatidylethanolamine (PE) ratio increased significantly (p< 0.01), indicative of increased phosphatidylethanolamine methyltransferase (PEMT) activity. The protein levels of protein arginine methytransferase 1 (PRMT1) increased significantly, but its products, monomethylarginine (MMA) and asymmetric dimethylarginine (ADMA), decreased significantly. Circulating ADMA increased and approached significance (p< 0.06). Protein expression of methionine adenosyltransferase 1A, cystathionine β-synthase, γ-glutamylcysteine synthetase, betaine-homocysteine methyltransferase, and methionine synthase remained unchanged. Although gene expression of the DNA methyltransferase Dnmt3a decreased, the global DNA methylation was unaltered. Among individual genes, only HMG-CoA reductase (Hmgcr) was hypermethylated, and no methylation changes were observed in fatty acid synthase (Fasn), nuclear factor of kappa light polypeptide gene enhancer in B-cells 1 (Nfκb1), c-Jun, B-cell lymphoma 2 (Bcl-2) and Caspase 3. NAFLD was associated with hepatic methionine deficiency and homocysteine elevation, resulting mainly from impaired homocysteine remethylation, and aberrancy in methyltransferase reactions. Despite increased PRMT1 expression, hepatic ADMA was depleted while circulating ADMA was increased, suggesting increased export to circulation.

Age-Related Lipid Metabolic Signature in Human LMNA-Lipodystrophic Stem Cell-Derived Adipocytes.

Lamin A (LMNA)-linked lipodystrophies belong to a group of clinical disorders characterized by a redistribution of adipose tissue with a variable range of metabolic complications. The leading cause of these disorders is the nonphysiological accumulation of the lamin A precursor, prelamin A. However, the molecular mechanisms by which prelamin A induces the pathology remain unclear. The aim of this study is to use an experimental LMNA-lipodystrophy model based on human mesenchymal stem cell (hMSC)-derived adipocytes that accumulate prelamin A to gain deeper insights into the mechanisms governing these diseases. Prelamin A-induced or -noninduced hMSC-derived adipocytes were obtained from healthy donors. The study was performed at the Biocruces Health Research Institute. Lipolytic activity was determined by the measurement of glycerol and free fatty acids. Ultrastructural analysis was performed by electron microscopy. Flow cytometry was used to assess mitochondrial membrane potential, and ultra-performance liquid chromatography coupled to mass spectrometry was used to explore lipid profiles. Prelamin A accumulating hMSC-derived adipocytes revealed increased lipolysis, mitochondrial dysfunction, and endoplasmic reticulum stress. Accumulation of prelamin A induces an altered lipid profile characterized by reduced diacylglyceride content, a higher ratio of monounsaturated over polyunsaturated fatty acids, and decreased stearoyl-coenzyme A desaturase-1 activity. In contrast, the ratio of diacylglycerophosphatidylcholine over diacylglycerophosphatidylethanolamine and the activity of phosphatidylethanolamine-methyltransferase were increased. Prelamin A accumulation causes mitochondrial dysfunction, endoplasmic reticulum stress, and altered lipid metabolism resembling a premature aging phenotype.

Characterization of Leishmania major phosphatidylethanolamine methyltransferases LmjPEM1 and LmjPEM2 and their inhibition by choline analogs

Phosphatidylcholine (PC) is the most abundant phospholipid in the membranes of the human parasite Leishmania. It is synthesized via two metabolic routes, the de novo pathway that starts with the uptake of choline, and the threefold methylation of phosphatidylethanolamine. Choline was shown to be dispensable for Leishmania; thus, the methylation pathway likely represents the primary route for PC production. Here, we have identified and characterized two phosphatidylethanolamine methyltransferases, LmjPEM1 and LmjPEM2. Both enzymes are expressed in promastigotes as well as in the vertebrate form amastigotes, suggesting that these methyltransferases are important for the development of the parasite throughout its life cycle. These enzymes are maximally expressed during the log phase of growth which correlates with the demand of PC synthesis during cell multiplication. Immunofluorescence studies combined with cell fractionation have shown that both methyltransferases are localized at the endoplasmic reticulum membrane. Heterologous expression in yeast has demonstrated that LmjPEM1 and LmjPEM2 complement the choline auxotrophy phenotype of a yeast double null mutant lacking phosphatidylethanolamine methyltransferase activity. LmjPEM1 catalyzes the first, and to a lesser extent, the second methylation reaction. In contrast, LmjPEM2 has the capacity to add the second and third methyl group onto phosphatidylethanolamine to yield (lyso)PC; it can also add the first methyl group, albeit with very low efficiency. Finally, we have demonstrated using inhibition studies with choline analogs that miltefosine and octadecyltrimethylammonium bromide are potent inhibitors of this metabolic pathway.

Aberrations of methyl group and homocysteine metabolism during the progression of diabetes in the ZDF rat

Altered methyl group and homocysteine (Hcy) metabolism was tissue‐specific, non‐transient, and preceded hepatic DNA hypomethylation in STZ‐induced type 1 diabetes. Similar perturbations occur in the Zucker (type 2) diabetic fatty (ZDF) rat, but the tissue specificity and effect of disease progression are unknown. ZDF and lean rats were killed at 12 and 21 wk of age. At 12 wk, hepatic glycine N‐methyltransferase (GNMT), methionine synthase, and cystathionine β‐synthase (CBS) activity/abundance were increased, whereas plasma Hcy was decreased in ZDF rats. At 21 wk, GNMT was induced in liver and kidney. In liver only, there was a trend toward increased CBS protein abundance (78%, p = 0.080) and betaine‐Hcy methyltransferase mRNA expression (~100%, p = 0.098). Phosphatidylethanolamine methyltransferase activity tended to be lower in ZDF liver (p =0.071) despite an increase (p &lt; 0.05) in mRNA expression. Hcy levels were decreased in plasma and kidney, but not in liver, at 12 and 21 wk. Elevated glutathione concentrations in liver and kidney at 12 wk, and in kidney at 21 wk, suggests altered regulation of redox homeostasis. Hepatic genomic DNA was hypermethylated at 12 and 21 wk, with a trend toward increased DNMT1 mRNA expression (p = 0.08) at 21 wk. In summary, alterations of methyl group and Hcy metabolism, redox status, and epigenetic regulation result during the progression of type 2 diabetes. Support: Am. Heart Assn.

Regulation of phospholipid synthesis in yeast

Phospholipid synthesis in the yeast Saccharomyces cerevisiae is a complex process that involves regulation by both genetic and biochemical mechanisms. The activity levels of phospholipid synthesis enzymes are controlled by gene expression (e.g., transcription) and by factors (lipids, water-soluble phospholipid precursors and products, and covalent modification of phosphorylation) that modulate catalysis. Phosphatidic acid, whose levels are controlled by the biochemical regulation of key phospholipid synthesis enzymes, plays a central role in the regulation of phospholipid synthesis gene expression.

Betaine administration corrects ethanol-induced defective VLDL secretion

Our previous studies, demonstrating ethanol-induced alterations in phosphatidylcholine (PC) synthesis via the phosphatidylethanolamine methyltransferase (PEMT) pathway, implicated a defect in very low-density lipoprotein (VLDL) secretion in the pathogenesis of hepatic steatosis. The objective of this study was to determine whether VLDL secretion was reduced by chronic ethanol consumption and whether betaine supplementation, that restores PEMT activity and prevents the development of alcoholic steatosis, could normalize VLDL secretion. The VLDL secretion in rats fed with control, ethanol and the betaine supplemented diets was determined using Triton WR-1339 to inhibit plasma VLDL metabolism. We observed reduced VLDL production rates in chronic alcohol-fed rats compared to control animals. Supplementation of betaine in the ethanol diet increased VLDL production rate to values significantly higher than those observed in the control diet-fed rats. To conclude, chronic ethanol consumption impairs PC generation via the PEMT pathway resulting in diminished VLDL secretion which contributes to the development of hepatic steatosis. By increasing PEMT-mediated PC generation, betaine results in increased fat export from the liver and attenuates the development of alcoholic fatty liver.

Effect of Transgenic Extrahepatic Expression of Betaine‐Homocysteine Methyltransferase on Alcohol or Homocysteine‐Induced Fatty Liver

Chronic alcohol feeding induces hyperhomocysteinemia (HHcy). Previously, we reported a protective role of betaine-homocysteine methyltransferase (BHMT) in homocysteine-induced injury in cultured hepatocytes. In this study, we investigated the direct role of BHMT in alcohol or homocysteine-induced liver injury. Betaine-homocysteine methyltransferase transgenic (Tg) mice were generated. Comparisons were made between the Tg and wild type (WT) mice in their response to intragastric alcohol infusion or to oral feeding of a high methionine low folate diet (HMLF). Expression of the Tg BHMT was increased in organs peripheral to the liver. The alcohol infusion for 4 weeks increased: plasma ALT by 5-fold in WT mice and 2.7-fold in Tg mice; plasma homocysteine by 7-fold in WT mice and 2-fold in Tg mice; liver triglycerides by 4-fold in WT mice and 2.5-fold in Tg mice. The alcohol-induced fatty liver was more severe in WT than in Tg mice based on H&E staining. The HMLF feeding for 4 weeks increased plasma ALT by 2-fold in WT mice and 1-fold in Tg mice; plasma homocysteine by 21-fold in WT mice and 3.3-fold in Tg mice; liver triglycerides by 2.5-fold in WT mice and 1.5-fold in Tg mice. HMLF induced accumulation of macro fat droplets in WT but not Tg mice. Betaine supplementation decreased partially the alcohol or HMLF-induced increase of ALT, homocysteine and liver lipids in WT mice. However, Tg mice were normal when fed both HMLF and betaine. In WT mice, both alcohol and HMLF induced moderate increase of sterol regulatory element binding protein 1 (SREBP1) protein which was partially reduced by betaine supplementation. In Tg mice, alcohol but not HMLF increased SREBP1. Carbohydrate responsive element-binding protein was increased by alcohol in either WT or Tg mice which was not affected by betaine supplementation. Ratio of S-adenosylmethionine (SAM) to S-adenosylhomocysteine (SAH) was reduced by 50% in WT and by 20% in Tg mice fed alcohol. Ratio of phosphatidylcholine (PC) to phosphatidylethanolamine (PE) was reduced in WT but not Tg mice fed alcohol. Changes in PE methyltransferase activities were not detected in response to alcohol or HMLF feeding but were increased by betaine. The BHMT Tg mice are resistant to alcohol or HMLF-induced HHcy and liver steatosis indicating that peripheral metabolism of homocysteine protected the liver without a direct effect of BHMT in the liver. Multiple mechanisms are involved in protection by betaine including increased SAM/SAH and PC/PE ratios.

Phosphatidylcholine containing docosahexaenoic acid (DHA) as a marker for in vivo phospatidylethanolamine methyltransferase: implications for brain development

Phosphatidylethanolamine methyltransferase (PEMT), which sequentially methylates phosphatidylethanolamine to phosphatidylcholine (PtdCho), is the body’s only pathway for de novo synthesis of choline. Mice lacking functional PEMT (PEMT −/−) quickly become choline deficient and require dietary choline for survival. PEMT −/− mice also have a substantial loss of PtdCho-DHA in liver and plasma, regardless of dietary choline intake. Therefore, we propose plasma PtdCho-DHA to be a useful, non-invasive marker of in vivo PEMT activity in humans. To test this, we used gas chromatography to measure PtdCho-DHA in plasma samples obtained from adult men and women as well as in primary human hepatocytes. PEMT activity using [3H]S-adenosylmethionine (a substrate for PEMT) was also measured in the hepatocytes. To date, plasma PtdCho-DHA was elevated in pre-menopausal women as compared to post-menopausal women and men, consistent with the ability of estrogen to induce PEMT (p<0.01). Furthermore, women with a single nucleotide polymorphism (SNP) in the PEMT gene that possibly decreases PEMT expression were found to have correspondingly less plasma PtdCho-DHA (p<0.05). With corresponding data in hepatocytes, PtdCho-DHA shows promise as a marker of in vivo PEMT activity in humans and could help with identifying individuals that may be at risk of choline deficiency. A deficiency in PEMT has also been shown to alter brain development in mice and loss of PtdCho-DHA may be partially responsible for these effects. Ongoing investigations explore the importance of PtdCho-DHA in fetal brain development.

Betaine attenuates alcoholic steatosis by restoring phosphatidylcholine generation via the phosphatidylethanolamine methyltransferase pathway

Previous studies in our laboratory implicated ethanol-induced decreases in hepatocellular S-adenosylmethionine to S-adenosylhomocysteine (SAM:SAH) ratios in lowering the activity of phosphatidylethanolamine methyltransferase (PEMT), which is associated with the generation of steatosis. Further in vitro studies showed that betaine supplementation could correct these alterations in the ratio as well as attenuate alcoholic steatosis. Therefore, we sought to determine whether the protective effect of betaine is via its effect on PEMT activity. Male Wistar rats were fed the Lieber DeCarli control or ethanol diet with or without 1% betaine supplementation for 4 weeks. We observed that ethanol feeding resulted in decreased phosphatidylcholine (PC) production by a PEMT-catalyzed reaction. Betaine supplementation corrected the ethanol-induced decrease in hepatic SAM:SAH ratios and by normalizing PC production via the PEMT-mediated pathway, significantly reduced fatty infiltration associated with ethanol consumption. This restoration of hepatocellular SAM:SAH ratio by betaine supplementation was associated with increases in the activity, enzyme mass and gene expression of the enzyme, betaine homocysteine methyltransferase (BHMT), that remethylates homocysteine. Betaine, by virtue of promoting an alternate remethylation pathway, restores SAM:SAH ratios that, in turn, correct the defective cellular methylation reaction catalyzed by PEMT resulting in protection against the generation of alcoholic steatosis.

Influence of pregnancy on the fatty acid composition of plasma phosphatidylcholine and on plasma choline concentrations in humans.

Dietary choline is used for hepatic synthesis of phosphatidylcholine (PtdCho) and spingomyelin (SM). Along with betaine, choline also serves as a methyl donor. We collected fasting blood samples at trimester 1 (11–15 weeks gestation), trimester 2 (19–23 weeks gestation) and trimester 3(34–37 weeks gestation) to assay the plasma concentration of these four compounds and fatty acid composition of PtdCho. Of the 15 women recruited, 12 had normal pregnancies. While plasma PtdCho concentrations increased significantly (P<0.05) from trimester 1 to 2 and maintained through to trimester 3, plasma choline concentrations increased gradually attaining significance (P < 0.001) during trimester 3. Betaine and spingomyelin concentrations significantly decreased late gestation. The plasma PtdCho fatty acid species derived from phosphatidyl ethanolamine methyl transferase (PEMT) activity, showed the most interesting changes; while 20:4 and 18:2 concentrations remained the same through pregnancy, 18:0 decreased in early gestation with no further depletion in late gestation. Multi-regression analysis showed that 18:0 and 20:4 were strong predictors of plasma choline concentrations (R2 =0.89; P<0.001) in trimester 3. Therefore during late gestation, PEMT pathway makes a greater contribution to plasma PtdCho composition. This spares the dietary supply of choline and therefore supports plasma choline increases.

Docosahexaenoic acid derived from phosphatidylcholine is decreased in choline deficient humans

Approximately 15–30% of the body’s need for choline is met by de novo synthesis using phosphatidylethanolamine methyltransferase (PEMT) which sequentially methylates phosphatidylethanolamine (PE) to form phosphatidylcholine (PtdCho). PE preferentially has long unsaturated fatty acids such as docosahexaenoic acid (DHA, C22:6) in the sn-2 position. In previous studies, we have shown that PEMT knockout mice significantly decreased PtdCho-DHA and choline pools in their livers and plasma. We were interested in whether this PtdCho-DHA could be a surrogate marker for liver PEMT activity, and therefore, provide information on choline status in humans. To that end, adult men and women were fed a diet containing 550 mg choline/day for 10 days. They were then fed a choline deficient diet for up to 42 days, before being repleted with graded amounts of choline. Blood was collected at the end of each phase, and plasma separated and analyzed for PtdCho-derived DHA using gas chromatography. To date, subjects who were deemed clinically choline deficient (developed hepatic steatosis) on the low choline diet had approximately 20% lower plasma PtdCho-DHA at the end of the depletion (p= 0.016) and the repletion phases (p= 0.003), when compared to the baseline phase (3.3 + 0.2 % of total fatty acids). Subjects who had no functional changes when fed a choline deficient diet for 42 days, had no differences in their plasma PtdCho-DHA. Thus, PtdCho-DHA may be a useful indicator of choline deficiency. This research is supported by grants from NIH- DK55865, DK56350 and RR00046.

Perturbations in choline metabolism cause neural tube defects in mouse embryos in vitro.

A role for choline during early stages of mammalian embryogenesis has not been established, although recent studies show that inhibitors of choline uptake and metabolism, 2-dimethylaminoethanol (DMAE), and 1-O-octadecyl-2-O-methyl-rac-glycero-3-phosphocholine (ET-18-OCH3), produce neural tube defects in mouse embryos grown in vitro. To determine potential mechanisms responsible for these abnormalities, choline metabolism in the presence or absence of these inhibitors was evaluated in cultured, neurulating mouse embryos by using chromatographic techniques. Results showed that 90%-95% of 14C-choline was incorporated into phosphocholine and phosphatidylcholine (PtdCho), which was metabolized to sphingomyelin. Choline was oxidized to betaine, and betaine homocysteine methyltransferase was expressed. Acetylcholine was synthesized in yolk sacs, but 70 kDa choline acetyltransferase was undetectable by immunoblot. DMAE reduced embryonic choline uptake and inhibited phosphocholine, PtdCho, phosphatidylethanolamine (PtdEtn), and sphingomyelin synthesis. ET-18-OCH3 also inhibited PtdCho synthesis. In embryos and yolk sacs incubated with 3H-ethanolamine, 95% of recovered label was PtdEtn, but PtdEtn was not converted to PtdCho, which suggested that phosphatidylethanolamine methyltransferase (PeMT) activity was absent. In ET-18-OCH3 treated yolk sacs, PtdEtn was increased, but PtdCho was still not generated through PeMT. Results suggest that endogenous PtdCho synthesis is important during neurulation and that perturbed choline metabolism contributes to neural tube defects produced by DMAE and ET-18-OCH3.

Liver diseases by alcohol and hepatitis C: early detection and new insights in pathogenesis lead to improved treatment.

Much progress has been made in the understanding of the pathogenesis of alcoholic liver disease, resulting in improvement of treatment. Therapy must include correction of nutritional deficiencies, while taking into account changes of nutritional requirements. Methionine is normally activated to S-adenosylmethionine (SAMe). However, in liver disease, the corresponding enzyme is depressed. The resulting deficiencies can be attenuated by the administration of SAMe but not by methionine. Similarly, phosphatidylethanolamine methyltransferase activity is depressed, but the lacking phosphatidylcholine (PC) can be administrated as polyenylphosphatidylcholine (PPC). Chronic ethanol consumption increases CYP2E1, resulting in increased generation of toxic acetaldehyde and free radicals, tolerance to ethanol and other drugs, and multiple ethanol-drug interactions. Experimentally, PPC opposes CYP2E1 induction and fibrosis. Alcoholism and hepatitis C infection commonly co-exist, with acceleration of fibrosis, cirrhosis, and hepatocellular carcinoma. PPC is being tested clinically as a corresponding antifibrotic agent. Available antiviral agents are contraindicated in the alcoholic. Anti-inflammatory agents, such as steroids, may be selectively useful. Finally, anticraving agents, such as naltrexone or acamprosate, should be part of therapy.

Alcoholic liver injury: pathogenesis and therapy in 2001

Much progress has been made in the understanding of the pathogenesis of alcoholic liver disease, resulting in improvement of prevention and promising prospects for even more effective treatments. It continues to be important to replenish nutritional deficiencies when present but it is crucial to recognize that, because of the alcohol-induced disease process, some of the nutritional requirements change. For instance, methionine, one of the essential amino acids for humans, must be activated to SAMe but, in severe liver disease, the activity of the corresponding enzyme is depressed. Therefore, the resulting deficiencies and associated pathology can be attenuated by the administration of SAMe, but not by methionine. Similarly, phosphatidylethanolamine methyltransferase (PEMT) activity, which is important for hepatic phosphatidylcholine (PC) synthesis, is also depressed in alcoholic liver disease, therefore calling for administration of the products of the reaction. It might also be beneficial to add other compounds to such therapeutic regiment. Since free radical generation by the ethanol-induced CYP2E1 plays a key role in the oxidative stress, inhibitors of this enzyme have great promise. Several have been investigated experimentally and PPC is particularly interesting because of its innocuity. In view of the striking negative interaction between alcoholic liver injury and hepatitis C, an antiviral agent is eagerly awaited that, unlike Interferon, is not contraindicated in the alcoholic. Anti-inflamatory agents are also required. In addition to down-regulators of cytokines and end toxic are being considered. Finally, since excess drinking is the crux of the issue, anticraving agents should be incorporated in any contemplated therapeutic cocktail, in view of the recent promising results obtained with some of these agents such as naltrexone and acamprosate.

ALCOHOL: its metabolism and interaction with nutrients.

In the past, alcoholic liver disease was attributed exclusively to dietary deficiencies, but experimental and judicious clinical studies have now established alcohol's hepatotoxicity. Despite an adequate diet, it can contribute to the entire spectrum of liver diseases, mainly by generating oxidative stress through its microsomal metabolism via cytochrome P4502E1 (CYP2E1). It also interferes with nutrient activation, resulting in changes in nutritional requirements. This is exemplified by methionine, one of the essential amino acids for humans, which needs to be activated to S-adenosylmethionine (SAMe), a process impaired by liver disease. Thus, SAMe rather than methionine is the compound that must be supplemented in the presence of significant liver disease. In baboons, SAMe attenuated mitochondrial lesions and replenished glutathione; it also significantly reduced mortality in patients with Child A or B cirrhosis. Similarly, decreased phosphatidylethanolamine methyltransferase activity is associated with alcoholic liver disease, resulting in phosphatidylcholine depletion and serious consequences for the integrity of membranes. This can be offset by polyenylphosphatidylcholine (PPC), a mixture of polyunsaturated phosphatidylcholines comprising dilinoleoylphosphatidylcholine (DLPC), which has high bioavailability. PPC (and DLPC) opposes major toxic effects of alcohol, with down-regulation of CYP2E1 and reduction of oxidative stress, deactivation of hepatic stellate cells, and increased collagenase activity, which in baboons, results in prevention of ethanol-induced septal fibrosis and cirrhosis. Corresponding clinical trials are ongoing.

Hepatic, Metabolic, and Nutritional Disorders of Alcoholism: From Pathogenesis to Therapy

Much progress has been made in the understanding of the pathogenesis of alcoholic liver disease, resulting in an improvement in treatment. Nutritional deficiencies should be corrected when present but, because of the alcohol-induced disease process, some of the nutritional requirements change. For instance, methionine, one of the essential amino acids for humans, must be activated to S-adenosylmethionine (SAMe), but, in severe liver disease, the activity of the corresponding enzyme is depressed. Therefore, the resulting deficiencies and associated pathology can be attenuated by the administration of SAMe, but not by methionine. Similarly, phosphatidylethanola-mine methyltransferase (PEMT) activity, which is important for hepatic phosphatidylcholine (PC) synthesis, is also depressed in alcoholic liver disease, therefore calling for the administration of the products of the reaction. Inasmuch as free radical generation by the ethanol-induced CYP2E1 plays a key role in the oxidative stress, inhibitors of this enzyme have great promise and PPC, which is presently being evaluated clinically, is particularly interesting because of its innocuity. In view of the striking negative interaction between alcoholic liver injury and hepatitis C, an antiviral agent is eagerly awaited that, unlike Interferon, is not contraindicated in the alcoholic. Antiinflamatory agents may also be useful. In addition to steroids, down-regulators of cytokines and endotoxin are being considered. Finally, anticraving agents such as naltrexone or acamprosate should be incorporated into any contemplated therapeutic cocktail.

Alcoholic liver disease: New insights in pathogenesis lead to new treatments

Much progress has been made in the understanding of the pathogenesis of alcoholic liver disease, resulting in improvement of prevention and therapy, with promising prospects for even more effective treatments. The most successful approaches that one can expect to evolve are those that deal with the fundamental cellular disturbances resulting from excessive alcohol consumption. Two pathologic concepts are emerging as particularly useful therapeutically. Whereas it continues to be important to replenish nutritional deficiencies, when present, it is crucial to recognize that because of the alcohol-induced disease process, some of the nutritional requirements change. This is exemplified by methionine, which normally is one of the essential amino acids for humans, but needs to be activated to S-adenosylmethionine (SAMe), a process impaired by the disease. Thus, SAMe rather than methionine is the compound that must be supplemented in the presence of significant liver disease. Indeed, SAMe was found to attenuate mitochondrial lesions in baboons, replenish glutathione, and significantly reduce mortality in patients with Child A or B cirrhosis. Similarly, polyenylphosphatidylcholine (PPC) corrects the ethanol-induced hepatic phospholipid depletion as well as the decreased phosphatidylethanolamine methyltransferase activity and opposes oxidative stress. It also deactivates hepatic stellate cells, whereas its dilinoleoyl species (DLPC) increases collagenase activity, resulting in prevention of ethanol-induced septal fibrosis and cirrhosis in the baboon. Clinical trials with PPC are ongoing in patients with alcoholic liver disease. Furthermore, enzymes useful for detoxification, such as CYP2E1, when excessively induced, become harmful and should be down-regulated. PPC is one of the substances with anti-CYP2E1 properties that is now emerging. Another important aspect is the association of alcoholic liver disease with hepatitis C: a quarter of all patients with alcoholic liver disease also have markers of HCV infection, with an even higher incidence in some urban areas but, at present, no specific therapy is available since interferon is contraindicated in that population. However, in addition to antiviral medications, agents that oppose oxidative stress and fibrosis should also be tested for hepatitis C treatment since these two processes contribute much to the pathology and mortality associated with the virus. In addition to antioxidants (such as PPC, silymarin, α-tocopherol and selenium), anti-inflammatory medications (corticosteroids, colchicine, anticytokines) are also being tested as antifibrotics. Transplantation is now accepted treatment in alcoholics who have brought their alcoholism under control and who benefit from adequate social support but organ availability is still the major limiting factor and should be expanded more aggressively. Finally, abstinence from excessive drinking is always indicated; it is difficult to achieve but agents that oppose alcohol craving are becoming available and they should be used more extensively.